Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 35 051087 | OH |
N | 208600000X | Surgeon | 35 051087 | OH |
Y | 2086S0102X | Surgical Critical Care | 35-051087 | OH |
NPI | 1295703122 |
---|---|
Provider Name | Dr. Kenneth Davis JR. |
First Address | Cincinnati, OH 45263-6256 |
Second Address | Cincinnati, OH 45219-2364 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/03/2006 |
Last Update Date | 09/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0571804 | (05) | OH |
64786429 | (05) | KY |
A15925 | (02) | OH |
P00442454 | RAILROAD MEDICARE (01) |